St. Luke's Center of Sleep Medicine strives to maintain quality care and education for patients suffering from sleep disorders. This is information is given to you, so you understand the sleep study process.
Ordering and scheduling your sleep study.
Your physician will be ordering your sleep study and in some cases your doctor may schedule your sleep study. If your physician's office does not schedule your test, when an order is obtained by the sleep center, you will be contacted by one of our office staff to schedule your test. A brief over the phone questionnaire will be obtained to find out a little about your medical history and a few simple questions about your sleep habits. A packet may be sent to you. If your primary doctor orders the sleep study our independent board certified sleep physicians will be reading and interpreting your sleep study. We are an accredited sleep center and are required to have board certified sleep physicians interpret the results of your test.
The check-in process.
You will be asked to update your information and sign forms regarding release of information, your rights and responsibilities. A sleep staff member will take your picture to be included in your sleep study report. Your information will be held in confidence only being released to the people needed to process that information.
The room orientation.
The technologist will explain the usage of The Sleep Number Bed control, TV control, intercom system, video camera (this is needed for the Sleep Specialist and scoring team to evaluate your recording), room thermostat and restroom availability. Please let the technologist know if you have any comfort issues such as room temperature or if you feel ill. The technologist is here to help make your stay as pleasant as possible.
The type of sleep study ordered.
The technologist will explain what type of test was ordered by your referring doctor. The technologist can not tell you their opinion of the sleep study or data obtained, they are not doctors. St. Luke's has independent physicians that are Board Certified Sleep Specialists and are qualified to make diagnoses and recommendations to your doctor.
Diagnostic Only Study - This baseline sleep study is performed to diagnose Sleep Disordered Breathing. CPAP (PAP or positive pressure therapy) will not be administered during this study. Based on your results your doctor may be order a PAP Titration Study.
Split-Night Study - This study is performed to diagnose Sleep Disordered Breathing and may result in the administration of PAP. The treatment phase may be administered if the patient has sufficient sleep time and has enough breathing disturbances to meet the lab criteria. Some patients will be placed on the PAP and the technologist will adjust the PAP pressure following the departmental guidelines. The guidelines we follow are in accordance with the American Academy of Sleep Medicine Standards of Care Practices. This could include the use of Bi-Level pressure (an inspiratory and expiratory dual level pressure) or a Servo Titration (special ventilation mode that adjusts for more complicated diagnosis). Some patients that are diagnosed with Sleep Apnea but did not meet the PAP treatment phase criteria will be ordered a second night PAP Titration Study. This study is to determine the level of treatment your doctor needs to prescribe. Some patients may be diagnosed as negative for Sleep Disordered Breathing and recommendations for their care will be included in the sleep report sent to their doctor.
CPAP Titration Study - This study is performed to treat patients with a previous diagnosis of Sleep Disordered Breathing. Your technologist will adjust the PAP pressure following the departmental guidelines. The guidelines we follow are in accordance with the American Academy of Sleep Medicine Standards of Care Practices. This could include the use of Bi-Level pressure (an inspiratory and expiratory dual level pressure) or a Servo Titration (special ventilation mode that adjusts for more complicated diagnosis).
Polysomnogram Followed by Multiple Sleep Latency Testing (MSLT) - This study may be performed to provide a valid assessment of sleepiness or wakefulness of a patient. The patient will have an overnight sleep study followed by a series of 4-5 naps 1.5 -2 hours apart. The MSLT or nap series will be cancelled if Sleep Disordered Breathing or Periodic Leg Movements are present on the overnight sleep test. A urine drug screen will be required.
Maintenance Wakefulness Testing (MWT) - This study is performed to assess the individual's ability to remain awake. The overnight sleep study is optional and may be ordered by the doctor. This study is used to for patients who are employed in occupations involving public transportation or safety may require assessment of their ability to remain awake. This test consists of 4-40 minute trials with 2 hours time between each trial. A urine drug screen will be required.
The education process.
The technologist will put a video on to help prepare you for the study and understand about more Sleep Disordered Breathing. The technologist will also desensitize (help you adjust to PAP) you to PAP by placing you on a mask prior to your study. This is beneficial to the technologist in determining what mask may best work for you and will help you get comfortable with the treatment. The lab has brochures available to you in the rooms and you may request more information to take with you.
The set-up process.
The technologist will have you change into your sleepwear and sit in a chair for the set-up or wiring process. Your head will be measured and marked with a washable marker to indicate where the electrodes are to be placed. The head electrodes will be gently scrubbed with an abrasive electrode gel, filled with a dissolvable paste and affixed to your scalp with paste and gauze. The face electrodes with be scrubbed and filled the same way but attached with tape. We have hypoallergenic tapes please let your technologist know if you have sensitivities to tape. These electrodes help determine the stages of sleep and brain activity. The heart will be monitored by 2 EKG electrodes snapped on to EKG pads on you chest. The breathing pattern will be monitored by 2 respiratory belts placed around the chest and abdomen, an airflow sensor above the lip and a nasal flow cannula the rests in the nostrils. The snore will be monitored by a snore microphone attached to the neck along with 2 leg leads attached to the lower legs that monitor leg movements. The oxygen level is monitored by a finger probe. All of these wires will be bundled together in a "pony tail" with Velcro to make it possible for you to move freely in the bed. Please understand that all of these things are necessary in understanding what is happening during your sleep.
The monitoring process.
Before starting your study and at the end of your study the technologist will do a calibration of the equipment. They will ask you to do various things such as open and close your eyes. This process takes about 5-8 minutes and the tech will explain each task as they go along. If you are having trouble hearing the technologist this is a good time to point that out. During the course of the night if you need anything or are experiencing any problem speak up so the technologist can address those issues. The technologist is usually responsible in setting up, monitoring and caring for 2 patients. During the course of the night you will be monitored by a camera with infrared lighting. This will be encrypted on your study for the use of the scorers and the Sleep Specialist in preparing your record. The technologist will let you know when the camera and intercom are in use so you can understand your privacy limitations. The technologist will usually turn on these devices after you have changed and are ready for the wiring process. The technologist will be making valuable notes and observing you will you sleep and if treatment is indicated they will place you on the PAP machine. You need only to speak and the technologist will be able to hear you. You do not have to press any buttons to activate the system. The technologist will be observing your sleeping pattern, breathing pattern, movements, snoring, heart rhythm and oxygen levels. The technologists are licensed in respiratory therapy and sleep medicine and are trained to alert the medical staff if they observe or you bring forward concerning medical issues.
The treatment phase.
If you have met the criteria for the treatment phase the technologist will be putting on a PAP mask. Typically they will start off with a nasal mask or nasal prong style interface. During the test if the patient has comfort or mask leak issues the technologist will change out or adjust the mask to ensure that is effective. Remember they will only change the mask if you ask for a change or the reading is showing that it is ineffective. We understand that the combination of the wires and the mask make for a difficult night but the data needs to be gathered to help you. Remember at home the wires will not be necessary and the mask can be changed out if you struggle with it at home. For the treatment phase we need your help. We ask you to communicate with the technologist so they can adjust the mask optimally for performance and comfort. Secondly, we need you to bear with us and try to relax and put your mind elsewhere since we need sleep time. The Sleep Specialist will review all written information and the sleep study itself to determine what treatment level should be prescribed.
The discharge process.
The technologist will wake you after the appropriate data is achieved. This means that typically we wake patients between 5:30-6:30 AM. Sometimes we need more time on the last PAP level and it is important to understand that our goal is in trying to achieve a quality treatment level. This is to your benefit so it may be needed for you to arrange to stay a little longer. This usually means about an hour longer (7:30 am). Some patients automatically awaken and can not go back to sleep so the Sleep Specialist may recommend a return visit to finish the PAP titration. This usually occurs when someone has the Split Night Sleep Study or goes on treatment and has trouble falling asleep. We don't want you to focus too much on that because that may add to your difficulty relaxing. If you go to sleep early please remind the technologist of that so they can wire you up earlier and get you to go to sleep at your usual bedtime. The wires will be removed after you wake and that process is much quicker then the set-up. The technologist will have a survey, checklist and a discharge sheet for you to sign before you leave. You will be given a copy of your discharge sheet.
Obtaining your rest result.
Your record will need to be scored, reported and reviewed by the Sleep Specialist. His impressions and recommendations will be faxed and mailed to your referring doctor. This process usually takes 10-14 working days. If you have not received a call regarding your results please call the referring doctor that sent you for this test.
St. Luke's continuing patient aftercare support.
St. Luke's Center of Sleep Medicine recognizes that the journey with PAP may be difficult for some patients. We have the St. Luke's Center of Sleep Medicine Continuing Patient Aftercare Program. We have 2 programs designed to help with your care as an extended patient care service. We hold CPAP seminars for patients that provide education and support for Sleep Disordered Breathing suffers. A Sleep Specialist talks on various topics and PAP companies set up displays with the most updated masks and machines. The other program is called the desensitization PAP Clinic it is held at the St. Luke's Kirby Glen location on Wednesdays only. The desensitization clinic has 3 components education, mask refit and relaxation techniques used to get comfortable with your PAP. If you are interested in using these services call our sleep office any they can put you on our seminar mail-out list or schedule you for the desensitization CPAP Clinic. If you are prescribed CPAP the doctor's office, sleep center and or the equipment company will call you to check on you. Please be sure to return their calls and send in your data card if requested. You must be proactive in your health to reap the benefits. Remember if you need help you must call and notify someone one your healthcare team.